Fixed intramedullary nailing and percutaneous autologous concentrated bone-marrow grafting can promote bone healing in humeral-shaft fractures with delayed union

Treatment of humeral diaphyseal nonunion can be difficult and usually requires an extensive approach to the humerus with bone grafting, a procedure that could result in a lengthy operation with significant morbidity for the patient. The purpose of the present study is to describe a novel minimally invasive technique for the treatment of humeral-shaft fractures that do not demonstrate union progress within 16-24 weeks of injury. Fixed intramedullary nailing with percutaneously harvested and introduced autologous concentrated bone-marrow cells (mixed with demineralised bone matrix putty) was successfully used to treat five patients who had delayed union of a humeral-shaft fracture. The procedure was minimally invasive with no complications and resulted in sound union of all cases within 20 weeks. (C) 2009 Elsevier Ltd. All rights reserved.